Zoonosenforschung und Umsetzung in Deutschland im nationalen und

internationalen Kontext

Marcel Tanner

Swiss Tropical and Public Health Institute,

www.swisstph.ch

13. Februar 2014 2

Zoonotic and «one-health»-challenges -

SARS, Bird flu, H1N1,Hemorrhagic viruses (Ebola…) → Zoonoses Trypanosomiasis, Dengue, Buruli ulcer, … → Neglected diseases, re-emerging ↔ environment, often zoonoses and associated with social and political changes

Neglected diseases

Neglected people and animals Neglected health and social systems

1400 pathogens 800 cross barrier animal-humans 24% of diseases clear enviromental links

Approximate composition of determinants of health: Incremental contribution of climate change to the overall

determinants of health

Inadequate health systems

Lack of access to careLivestock

Other environmental determinants

Climate change

Lack of environmental sanitation

13. Februar 2014 4

The „one medicine“ by Calvin Schwabe‘s has ist origins in his work with Dinka pastoralists in Sudan in the 1960s „There is no difference of paradigm between human and veterinary medicine. Both sciences share a common body of knowledge in anatomy, physiology, pathology, on the origines of diseases in all species.“ Schwabe C. (1964, 1984 3rd Edition): Veterinary Medicine and Human Health. Williams and Wilkins, Baltimore

13. Februar 2014 5

What does Calvin Schwabe‘s „one medicine“ really mean? 1. Recognition of interdependence of humans and animals is

only part of one medicine and one health. It is necessary but not sufficient.

2. Most of the papers in conferences are limited to this aspect, some include broader interactions.

3. Little theory of “One health”, an operational definition could by that:

4. “One health” is anything that adds value to the health of animals and humans, or economic savings, not achievable without cooperation of the two medicines.

13.02.2014 6

One-Medicine - Related concepts Veterinary Public Health (VPH) 1. Contribution of veterinary sciences to Public Health (WHO): classical

zoonoses, food-borne diseases, new emerging diseases.

Natural Nidality of Transmissible Diseases 1. E. Pavlovsky (1966): Concept of “disease nidality”: Pathogens occupy

ecological niches much in the same manner as any living organism has a characteristic niche in nature

Ecosystem health (IDRC) 1. Vision of improved health and well-being, sustainable ecosystems, more

equitable development and less poverty.

Agro-ecosystem Health 1. Investigation of agricultural systems in holistic view encompassing

ecology, economy and health

Extension of health concept to whole ecosystem • From “one medicine” to “one health” and possibly “one well-being”

13.02.2014 7

Conceptual landscape of „one medicine“

Vet. medicine

One Medicine

One Health

Medicine

Ecohealth / Agro-ecosystem health

Syndrome Concept: mitigating syndromes of global change (NCCR)

From “us versus them” to “shared risks”

…. to Health in Social-Ecological Systems (HSES) (Zinsstag et al. PVM, 2011)

Health Outcomes: -Physical -Emotional -Spiritual (humans) Health and Wellbeing

Systems biology of Humans - Domesticated animals - Wildlife Hosts and their various levels of scales

Population

Social - Ecological System of Humans and Animals (SES)

Body

Psychological - Social – Cultural - Economic -Political – Determinants - Governance, Infrastructure, Education, - Public and animal health systems, - Burden of disease, Health economics - Livelihood, Vulnerability, Social resilience, Access, - Actor centred approach and construction of actors realities - Equity effectiveness of interventions, …. are also outcomes of health (mutual influence)

Tissue

Single cell

Molecule

Ecosystems and their health related components: Vectors, Pathogens

Vegetation and Natural resources Food, feed and Water

Urban – Rural: Industrial and agricultural production and pollution, …

Physical: Erosion, Climate change, …

Ecological Determinants and Outcomes of health -“Sustainability” -Resilience -Adaptive management -…. are also outcomes of health (mutual influence)

A step towards a „theory of development research“ Communication with non-Western Epistemologies

13.02.2014 9

Einfachste Lebensweise (low input)

Descriptive studies on zoonoses: Q-fever, Brucellosis Methodology: HDSS for mobile populations Health systems and interventions: Vaccination services in Sahel Urban zoonoses: Rabies elimination through vaccination of dogs Economic benefit and interventions: Brucellos central Asia/Mongolia, rabies

13.02.2014 10

Joint human and animal disease surveillance

11 Verbundprojekte (Zoonosenverbünde) mit über 95 Teilprojekten gefördert: • FBI-Zoo - Lebensmittelbedingte zoonotische Infektionen beim Menschen • FluResearchNet - Pathogenität und Speziestransmission von Influenza A-Viren • Lyssaviren - eine potentielle Gesundheitsgefahr • MedVet-Staph - Interdisziplinäres Forschungsnetzwerk zur zoonotischen

Bedeutung von Staphylococcus aureus / MRSA • Pathogenese, Diagnostik und Epidemiologie des Q-Fiebers in Deutschland • RESET - Resistenzen bei Tier und Mensch - gemeinsame Forschung in

Deutschland • SARS - Ökologie und Pathogenese einer archetypischen Zoonose • Toxonet02 - Ein Netzwerk zur Toxoplasmose bei Mensch und Tier in

Deutschland • VibrioNet: Vibrio-Infektionen durch Lebensmittel und Meerwasser in Zeiten

des Klimawandels • ZooMAP - Paratuberkulose: Von der Johne'schen Krankheit zum Morbus Crohn • Zoonotische Chlamydien - Modelle für chronische und persistente Infektionen

bei Mensch und Tier

13.02.2014 11

13.02.2014 12

Conceptual landscape of „one medicine“

Vet. medicine

One Medicine

One Health

Medicine

Ecohealth / Agro-ecosystem health

Syndrome Concept: mitigating syndromes of global change (NCCR)

From “us versus them” to “shared risks”

Publications: Zoonoses - Germany

13.02.2014 13

Zoonoses - Germany: Citations and consequences

13.02.2014 14

• Boost relatively late in relation to international agenda • Platform/consortia approaches relatively late • Zoonotic interactions and relevance of zoonoses • Late international recognition • National focus • Little translational aspects or systemic approaches for impact

Foodborne outbreaks 2007 - 2011

13.02.2014 15 Zoonosenbericht 2011, BfR

Salmonella 2001 - 2011

13.02.2014 16 Zoonosenbericht 2011, BfR

Campylobacter 2002 - 2011

13.02.2014 17 Zoonosenbericht 2011, BfR

EHEC 2002 - 2011

13.02.2014 18 Zoonosenbericht 2011, BfR

Listeria 2002 2011

13.02.2014 19 Zoonosenbericht 2011, BfR

The systems context

Efficacy

X Access

X Targeting Accuracy

X Provider Compliance

X Consumer Adherence

= Effectiveness

80%

x 80%

x 75%

X 75%

= 29%

x 80%

From Efficacy to Effectiveness

Q-fever in the Netherlands (2007) Enserink M. (2010) Science (327) 266-267.

Lack of communication between Veterinary and Public Health sectors

13. Februar 2014 22

Key actions: The unfinished “One Health” (Zinsstag et al. 2009 Veterinaria Italiana)

1. Joint disease surveillance for humans an animals (Labs and IT)

2. Joining cancer registries for humans and animals

3. Joint surveillance of antimicrobial resistance (e.g. CIPARS, Canada)

4. Better use of the human-animal bond for the control of non-communicable disease like depression or obesity. Communication: It should just become normal that doctors and veterinarians work together as closely as possible.

5. Worldbank estimates > 6 Billion USD annual savings from closer cooperation between human and animal health in infrastructure, institutional reform and communication (2011).

13.02.2014 23

Zoonoses and „One health“ today and in future

1. Comparative Pathology 2. Joint human and animal epidemiological studies 3. Human health benefits of interventions in animals 4. Joint human and animal health services 5. Joint surveillance: risks, antibiotic resistance… 6. Joint systemic approaches – incl. population dynamics

System basedResource based

Livelihoods approach

Livestock(System)(System)

Agriculture Forestry

Pastures(Management)(Management)

Water Land

Human(Well being and social equity)(Well being and social equity)

Equity access to services and resources

Surveillance as intervention / surveillance – response approaches

13.02.2014 24

Towards living „one health“ • Integrated human and animal disease surveillance 1. Demographic Surveillance Systems, including community

surveillance leading also to cost savings • Integrated human and animal epidemiological study design. • Integrated human and animal health services provision • Institutional reform and public health reforms including

communication Germany: - Extend scope to systemic and transdisciplinary approaches - Pursue translational medicine and translational public health

concept – including surveillance and forecasting in a decentralized system:

- Become truly international: From approaches (questions, consortia) to funding (Horizon2020, Wellcome Trust, BMGF…)

- Develop and validate surveillance – response systems

13. Februar 2014 25

Beyond „One Health“: Towards Health in Social-Ecological Systems (SES)

Health of animals and humans are part of and determined by SES:

A diagnostic approach for going beyond panaceas in natural resource management (Ostrom, PNAS 2007, Nobel Laureate in Economics 2009)

1. Zoonosen 26

Mixed teams to integrate human and animal health

Thank you very much

13/02/2014 27